The growing corporate dominance in U.S. medical care has been a major factor in the increasingly inequitable distribution of health care resources and the declining public health conditions in poor and minority urban communities. Alongside this trend has been a parallel phenomenon of economic disinvestment and political neglect in these same at-risk neighborhoods. This article analyzes these trends as related components of austerity, retrenchment, and capital consolidation policies that have characterized the U.S. political economy for several decades. Emphasized are the relationships among corporatization, capital consolidation, deindustrialization of the workforce, and medical indigence; the resulting economic stress placed upon community hospitals and other caregivers in poor and minority communities; and the marked discrepancy between conditions of development and underdevelopment in American cities. It is argued that the effects of these policies are pathogenic in nature: they place populations at risk for disease and social dysfunction, they reduce access to necessary preventive and curative services, and they weaken coping mechanisms. Community economic development, empowerment, and a direct challenge to the growing concentration of wealth and power in the corporate class are proposed as essential elements of public health policy.
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References
1.
SalmonJ. W.The health maintenance organization strategy. In The Corporate Transformation of Health Care: Vol. 1, Issues and Directions, edited by SalmonJ. W., pp. 83–96. Baywood, Amityville, N.Y., 1990.
2.
1993—A boom year for healthcare mergers and acquisitions. Mod. Healthcare23(48): 6, 1994.
3.
SalmonJ. W.Introduction. In The Corporate Transformation of Health Care: Vol. 2, Perspectives and Implications, edited by SalmonJ. W., pp. 1–28. Baywood, Amityville, N.Y., 1994.
4.
SalmonJ. W.Introduction. In The Corporate Transformation of Health Care: Vol. 1, Issues and Directions, edited by SalmonJ. W., pp. 5–12. Baywood, Amityville, N.Y., 1990.
5.
MundingerM. O.Health service funding cuts and the declining health of the poor. N. Engl. J. Med.313(1): 44–47, 1985.
6.
BodenheimerT. S.The fruits of empire rot on the vine: United States health policy in the austerity era. Soc. Sci. Med.28(6): 531–538, 1989.
7.
EpsteinA. M.SternR. A.WeissmanJ. S.Do the poor cost more? A multihospital study of patients' socioeconomic status and use of resources. N. Engl. J. Med.32(16): 1122–1128, 1990.
8.
HadleyJ.SteinbergE. P.FederJ.Comparison of uninsured and privately insured patients. JAMA265(3): 374–379, 1991.
9.
TerrisM.Determinants of health: A progressive political platform. J. Public Health Policy15(1): 5–17, 1994.
10.
BrownE. R.Rockefeller Medicine Men, pp. 218–225. University of California Press, Berkeley, 1979.
11.
LastJ. M. (ed.) A Dictionary of Epidemiology. Oxford University Press, New York, 1983.
12.
TurshenM.The Politics of Public Health, pp. 33–49. Rutgers University Press, New Brunswick, N.J., 1989.
13.
AdayL.At Risk in America. Jossey-Bass, San Francisco, 1993.
14.
BenensonA. S. (ed.) Control of Communicable Diseases in Man, Ed. 15, pp. 500, 506. American Public Health Association, Washington, D.C., 1990.
15.
RelmanA.What market values are doing to medicine. Atlantic Monthly269(3): 99–106, 1992.
16.
NavarroV.The crisis of the international capitalist order and its implications for the welfare state. In Issues in the Political Economy of Health Care, edited by McKinlayJ. B., Tavistock, New York, 1984.
17.
MarxK.Exposition of the internal contradictions of the law. In Capital, Vol. III, pp. 240–266. International Publishers, New York, 1967.
18.
Tomaskovic-DeveyD.MillerS. M.Recapitalization: The basic urban policy of the 1980s. In Urban Policy Under Capitalism, edited by FainsteinN. I.FainsteinS. S., p. 24. Sage, Beverly Hills, 1983.
19.
FasenfestD.Race, class, and community development: A comparison of Detroit's Poletown and Chicago's Goose Island. In Research in Urban Sociology, Vol. 1, edited by LembckeJ.HutchisonJ. R., pp. 107–133. Jai Press, Greenwich, Conn., 1989.
20.
SquiresG. D.Public-private partnerships: Who gets what and why. In Unequal Partnerships: The Political Economy of Urban Redevelopment in Postwar America, edited by SquiresG. D., p. 2. Rutgers University Press, New Brunswick, N.J., 1989.
21.
GordonD. M.Capitalist development and the history of American cities. In Marxism in the Metropolis, edited by TabbW. K.SawersL., pp. 21–53. Oxford University Press, New York, 1984.
22.
OtisL. H.Insurer redlining called un-American. National Underwriter98(21): 1, 12, 1994.
23.
KleniewskiN.From industrial to corporate city: The role of urban renewal. In Marxism in the Metropolis, edited by TabbW. K.SawersL., pp. 205–222. Oxford University Press, New York, 1984.
24.
Community Renewal Program. The Redevelopment Authority Program 1945–1962. Technical Report No. 6, pp. 67–68. Philadelphia, 1963.
25.
O'ConnorJ.The Fiscal Crisis of the State, p. 137. St. Martin's Press, New York, 1973.
26.
Joint Center for Housing Studies. The State of the Nation's Housing, 1994. Harvard University Press, Cambridge, Mass., 1995.
27.
BluestoneB.HarrisonB.Capital and Communities: The Causes and Consequences of Private Disinvestment. Progressive Alliance, Washington, D.C., 1980.
28.
What about the demand side? LRA'sEconomic Notes62(5): 1, 1994.
29.
DrennanM.The decline and rise of the New York economy. In Dual City: Restructuring New York, edited by MollenkopfJ.CastellsM., pp. 478–492. Russell Sage Foundation, New York, 1991.
30.
U.S. Department of Labor, Bureau of Labor Statistics. Current Population Survey. U.S. Government Printing Office, Washington, D.C., 1986.
31.
Displaced workers face rough road. LRA's Economic Notes62(10): 7, 1994.
32.
The joyless recovery. LRA's Economic Notes61(9): 1, 1994.
33.
Wage gap narrows, but… . LRA'sEconomic Notes62(6): 5, 1994.
34.
BrowneH.SimsB.Runaway America: U.S. Jobs and Factories on the Move. Resource Press, Albuquerque, N.M., 1993.
35.
HowlandM.Plant Closings and Worker Displacement: The Regional Issues, pp. 3–4. W. E. Upjohn Institute for Employment Research, Kalamazoo, Mich., 1988.
36.
BrowneH. Personal communication, March 7, 1995.
37.
Texas Employment Commission, Economic Research and Analysis Department. News release. El Paso, 1995.
38.
BowmanP. J.Work life. In Life in Black America, edited by JacksonJ. S., pp. 124–155. Sage, Newbury Park, Calif., 1991.
39.
RennerC.NavarroV.Why is our population of uninsured and underinsured persons growing? The consequences of “deindustrialization” in America. Annu. Rev. Public Health10: 85–94, 1989.
40.
CholletD.Employer-based health insurance in a changing work force. Health Aff. 13(1): 315–325, 1994.
41.
Facts Congress needs to know. LRA's Economic Notes62(7): 6, 1994.
42.
Employee Benefit Research Institute. Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 1994 Current Population Survey. Issue Brief No. 158. Washington, D.C., February 1995.
43.
CunninghamP. J.MonheitJ.Insuring the children: A decade of change. Health Aff. 9(4): 76–90, 1990.
44.
WhiteisD. G.SalmonJ. W.The proprietarization of health care and the underdevelopment of the public sector. In Beyond Crisis: Confronting Health Care in the United States, edited by McKenzieN. F., pp. 257–270. Penguin/Meridian, New York, 1994.
45.
WhiteisD. G.Hospital and community characteristics in closures of urban hospitals, 1980–87. Public Health Rep. 107(4): 409–416, 1992.
46.
BoehmB. L.MurrayS. M.Healthcare's future found in outpatient alternatives. Mod. Healthcare20(9): 24, 1990.
47.
BurnsJ.Caring for the community: Hospital programs provide a lifeline for the inner cities, but only a few are to be found. Mod. Healthcare23(45): 30–33, 1993.
48.
Centers for Disease Control. Homicide among young black males: 1978–1987. MMWR Morb. Mortal. Wkly. Rep.39: 869–873, 1990.
49.
RandM. R.Handgun Crime Victims. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Special Report. Washington, D.C., 1990.
50.
McKenzieN.BilofskyE.Shredding the safety net: The dismantling of public programs. Health/PAC Bull. 21(2): 5–11, 1991.
51.
SagerA.Why urban voluntary hospitals close. Health Serv. Res.18(3): 450–457, 1983.
52.
ThomasE.The geography of urban health care. Michigan Hosp. 27(5): 50, 1991.
53.
WilliamsD.HadleyJ.PettengillJ.Profits, community role, and hospital closure: An urban and rural analysis. Med. Care30(2): 174–187, 1992.
54.
McLaffertyS.Neighborhood characteristics and hospital closure. Soc. Sci. Med.16(19): 1667–1674, 1982.
55.
SchatzkinA.The relationship of inpatient racial composition and hospital closure in New York City. Med. Care22(5): 379–387, 1984.
56.
GrumbachK. G.Liberal benefits, conservative spending: The Physicians for a National Health Program proposal. In Beyond Crisis: Confronting Health Care in the United States, edited by McKenzieN. F., pp. 666–679. Penguin/Meridian, New York, 1994.
57.
GeigerH. J.The health care reform two-step. Health/PAC Bull. 23(2): 44–45, 1993.
58.
StarfieldB.Health systems' effects on healths status: Financing vs the organization of services. Am. J. Public Health85(10): 1350–1351, 1995.
59.
SalmonJ. W.Profit and health care: Trends in corporatization and proprietarization. In The Corporate Transformation of Health Care: Vol. 1, Issues and Directions, edited by SalmonJ. W., pp. 55–57. Baywood, Amityville, N.Y., 1990.
60.
FindlayS.Networks of care may serve as a model for health reform. Business and Health11(2): 27–31, 1993.
MontagueJ.The big question: Will high levels of uncompensated care make some providers unattractive to emerging networks?Hospitals & Health Networks, February 5, 1994, pp. 48–54.
63.
KennedyL.The losses in profits: How proprietaries affect public and voluntary hospitals. In Beyond Crisis: Confronting Health Care in the United States, edited by McKenzieN. F., pp. 295–309. Penguin/Meridian, New York, 1994.
64.
HolahanJ.Insuring the poor through Section 115 Medicaid waivers. Health Aff. 14(1): 199–216, 1995.
65.
VladekB. C.Perspective. Health Aff. 14(1): 199–216, 1995.
66.
WhiteisD. G.SalmonJ. W.Public Health Care Delivery Systems in Selected U.S. Cities: Findings of the Urban Public Health Care Systems Study Tours Project. University of Illinois College of Pharmacy, and Health and Medicine Policy Research Group, Chicago, 1990.
67.
WallaceD.Roots of increased health care inequality in New York. Soc. Sci. Med.31(11): 1219–1277, 1990.
68.
TrevinoF. M.JacobsJ. P.Public health and health care reform: The American Public Health Association's perspective. J. Public Health Policy15(4): 397–406, 1994.
69.
McKenzieN. F.Introduction. In Beyond Crisis: Confronting Health Care in the United States, edited by McKenzieN. F., pp. 399–405. Penguin/Meridian, New York, 1994.
